Wednesday, 16 May 2007

Some more snippets of info I'm trying to make sense of

I've taken out the snippets I feel useful at the moment. Articles often seem more geared towards school-age kids. The emphasis on a 'team' of professionals and a more structured approach also has me slightly concerned. All that's happening now with H. is quite haphazard. But then are we making an issue out of something that may have gone unnoticed if he'd been at home instead of nursery from an early age and then gained his confidence before being thrown into the 'real' world? Allah knows best and it' something else to feel guilty about. However can imagine if had kept him at home and he'd been mute in school / later on, the lack of nursery attendance would've been blamed, no-win situation.
Here's parts of an artlicle by Robert Schum:
SLP = Speech and language therapist.
'The SLP can also use techniques to help reduce the general anxiety of the child with selective mutism through direct intervention and collaboration with the classroom teacher. Routine and structure often help an anxious child. Clearly understanding activities and having a predictable schedule reduce the unknown. If a schedule is changed or a new activity occurs, a preview of this change can be helpful. Anxious children sometimes appear to be "slow to warm up." They might not jump right into a new activity, but first prefer to observe other children doing an activity until they are sure that they understand what to do. Once they engage in the activity, they may require some adult assistance at first, and then have the adult fade the assistance as the child becomes more confident in the skills. For example, in a kickball game, the child might want to first observe other students play, later start playing with adult assistance, and then independently join in.
In working with children who are mute, I usually use terms such as "shy" and "nervous" to describe feelings when they are reluctant to speak, and "brave" when they extend themselves in therapy or in the classroom. Most of my patients understand these terms, and I find them helpful to use with teachers and parents. UmSuhayb comment: Have read shouldn't use term 'shy' with the child?
Because children with selective mutism often show other anxiety symptoms, another treatment goal in the schools is to promote more spontaneity in behavior. In individual therapy, I often use various media to help the child be more spontaneous and less constricted in actions. For example, we draw with markers, cut paper, use modeling compounds, and get messy with finger paints. The approach is to reduce the child’s self-consciousness and inhibition. These media also afford the child opportunities to communicate in a nonverbal fashion. The SLP should know that the duration of mute symptoms is highly variable. I have had young patients show improvement in symptoms in several months, with no more than 12 sessions of therapy. I have had other patients whose symptoms have persisted for several years. I recommend that in consulting with teachers and parents, we caution them that it may take some time until the child is comfortable speaking spontaneously at school and in other social settings.

In this context, it is important to remember that the mutism is only one specific symptom of the social anxiety. Many times we can note improvement in other, nonverbal symptoms of anxiety. If we focus only on the mutism, we can become discouraged by the slow progress in the improvement of that symptom. However, if we take a broader view of the anxiety, we can often identify encouraging progress over a wider array of behaviors. The SLP can be of great help in counseling patience with other members of the team, including parents and teachers.

This integrated approach to therapy promises the best opportunity for the child’s success.
Additional references can be found in The ASHA Leader Online at
Robert Schum is a clinical psychologist and associate professor in the Department of Pediatrics at the Medical College of Wisconsin. His specialty is the assessment and treatment of children with communication disorders. Contact him by email at '

Also have advised nursery to try activities involving blowing,using mouth but not actually speech, eg bubbles, pingpong balls with straws.
Plus his preference for playing with younger children (less of a threat ?)

Need to advise re anxiety reduction (pictorial timetable, letting him know who he'll be with, relaxing activities, dough, baking, painting..)

Thursday, 10 May 2007

Must start getting serious

about helping my son, H, 3 1/2 years old. However the stuff so far I've read seems to indicate the more the problem is highlighted the worse it becomes and doing any sort of 'therapy' intrinsically highlights a problem?. I'm a qualified Speech and language therapist and I'm feeling overwhelmed.
Here's some stuff I got off the net to start with:

Identifying a child with SM
Children with Selective Mutism:
Find it difficult to make eye contact when they are anxious. They may turn their heads away and ignore you. One might assume they are being unfriendly, but they are fearful and just do not know how to respond.
Look blank or expressionless when anxious. In nursery or school they will be feeling fearful most of the time, which is why it is hard for them to smile, laugh or show true feelings, even when they have a wicked sense of humour.
Move stiffly or awkwardly when anxious, or if they think they are being watched.
Find it difficult to answer the register or say hello, goodbye or thank you. This can seem rude or hurtful but is not intentional.
Can be slow to respond to a question.
Worry more than other people.
Can be very sensitive to noise, touch or crowds.
Can be intelligent, perceptive and inquisitive.
Suggested strategies
If the child does not answer the register verbally, allow them to acknowledge their presence in other ways, such as a smile, a nod, a look or raising a hand. A teacher in an infants class encouraged all children at registration to make an animal noise instead of responding verbally, and this proved successful.
Encourage self-expression through creative, imaginative and artistic activities.
Sometimes sit the child at the front of the group for a story, to encourage attention and involvement.
In discussion and circle times, give the child the opportunity to speak and be patient when awaiting a response.
If the child is socially isolated, link them with other quiet, shy children, singly or in small groups. Play games involving interaction between pairs or the group, such as rolling a ball, pulling on quoits, rowing boats, ring games and rhymes.
Try non-verbal activities which require expelling air and using the mouth, for example blowing out candles, blowing bubbles, blowing ping pong balls with a straw.
Make noises for toy vehicles and animals in play situations or as sound effects for a story.
Introduce play with puppets, because the child may 'speak' through the puppet, especially from behind a screen. Masks may be helpful.
Encourage participation in noisy games and rhymes with predictable language such as 'What's the time, Mr Wolf?'
Use activities that focus on the senses to develop the child's self-awareness
This article was written by Alice Sluckin, Chair of the Selective Mutism Information and Research Association (SMIRA) and a former senior psychiatric social worker, for Nursery World, 17 February 2005. The Selective Mutism Information and Research Association can be contacted at 13 Humberstone Drive, Leicester LE5 0RE. Telephone: 0116 212 7411 (Tues, Wed & Fri, 4-7pm). Email: